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Saudi Med J. 2007 Jul;28(7):1039-43.

Free testosterone, luteinizing hormone/follicle stimulating hormone ratio and pelvic sonography in relation to skin manifestations in patients with polycystic ovary syndrome.

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  • 1Scientific Council of Dermatology and Venereology, Iraqi Board for Medical Specializations, Department of Biochemistry, Badhdad University, Iraq, and the Department of Gynecology, Alwasl Hospital, Dubai, United Arab Emirates.



To evaluate hormonal changes and pelvic sonography in polycystic ovary syndrome (PCOS) patients, especially free testosterone and their correlations with skin manifestations of this disease.


This prospective study was carried out in the Skin Clinic, Baghdad Teaching Hospital, Iraq in the period between April 2004-March 2005. We included 126 patients with PCOS in this study. Patients were divided into 3 groups according to the body mass index (BMI). Group I: normal weight (48 patients). Group II: overweight (n=29). Group III: obese (n=49). We included 75 healthy women as a control and divided into 3 groups according to their BMI: normal weight (n=35), overweight (n=25), and obese (n=15). All patients were evaluated for features of PCOS. Hormonal assay including serum and saliva free testosterone were determined with 3.2 pg/ml as the upper normal level for both. The luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio was performed in serum of samples obtained on day 2 or 3 of the natural cycle in menstruated women, and any time in women with amenorrhea, and the ratio of LH/FSH>or=2 was regarded as the significant level. In the control group, the sonography and LH/FSH estimation were carried for all, saliva free testosterone was measured for only 30. All did not fulfill the criteria of PCOS, although some had one of the criteria.


The age range was 15-39 (26.12+/-6.36) years with a mean BMI of 30.261+/-8.238. While the ages of 75 healthy control women ranged from 15-39 (28.82+/-6.45) years with a mean BMI of 26.99+/-4.41. Free saliva testosterone was abnormally elevated in 68, free serum testosterone elevated in 75, elevated LH/FSH ratio in 76, and positive U/S in 98 of patients. The free saliva testosterone and LH/FSH ratio were significantly increased in patients with PCOS in comparison with the control group. Frequency of skin manifestations was significantly increased in PCOS patients with abnormal saliva and serum free testosterone level in comparison with those of normal level hormones. There was a positive relationship between the increase in frequency of skin manifestations and increase in saliva and serum free testosterone levels, while their was no relation between LH/FSH ratio and frequency of skin manifestations.


Free testosterone level represents the most sensitive biochemical marker supporting the diagnosis of PCOS.

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